[HORROR, SHAME AND GUILT IN THE BEDROOM: THE EFFECTS OF EXPOSURE TO TRAUMA ON SEXUAL FUNCTION].

INTRODUCTION: Since the brutal October 7, 2023 attacks on Israel, the encroachment of the battlefield into the daily lives of all Israelis has impacted both civilians and combatants in various ways. The development of post-traumatic stress reactions has far-reaching effects across numerous aspects of life. One of the lesser-discussed consequences is the onset of sexual dysfunction. Reactions to such distressing events can adversely affect sexual desire, arousal, orgasm, the frequency of sexual activities, and satisfaction derived from them. These issues may present directly in clinical settings, or indirectly through other symptoms. The impact of trauma on sexual function can be attributed to disruptions in biological mechanisms, cognitive impairments, mood changes, and diminished motivation. This review explores how responses to post-traumatic stress relate to sexual function. We present case studies of patients recovering from such events, describe the underlying mechanisms that trigger these adverse reactions, and discuss interventions that can enhance sexual health, which can be implemented in primary care settings. It is advisable for assessments of sexual function to be included in routine evaluations by primary care physicians. Early identification of sexual dysfunction can help prevent the progression of more persistent issues and enhance overall quality of life for patients.

Oxytocin enhances group-based guilt in high moral disengagement individuals through increased moral responsibility.

Group-based guilt (collective guilt) refers to the negative emotions experienced when group members violate moral standards and can motivate prosocial behavior. Individuals exhibiting high levels of moral disengagement are prone to engaging in unethical conduct without experience of guilt, thereby prolonging or exacerbating conflicts and hindering conflict resolution. Oxytocin is believed to play key role in shaping social cognition and behaviors associated with morality and prosociality. So, this study (N = 79) explores oxytocin's potential to enhance group-based guilt and compensation for victims among individuals with high moral disengagement. Employing a randomized placebo-controlled design, participants received either oxytocin or placebo before undertaking a task designed to induce group-based guilt, during which they made decisions regarding the allocation of money to victims. Results revealed that participants with high moral disengagement who received oxytocin perceived higher levels of moral responsibility, experienced increased group-based guilt, and allocated significantly more money to victims compared to those who received the placebo. These findings suggested that oxytocin holds promise as an intervention to mitigate moral disengagement and foster moral behavior in individuals predisposed to avoiding responsibility and guilt feelings.

Posttraumatic survivor guilt is associated with white matter microstructure alterations.

BACKGROUND: Military veterans with posttraumatic stress disorder (PTSD) commonly experience posttraumatic guilt. Guilt over commission or omission evolves when responsibility is assumed for an unfortunate outcome (e.g., the death of a fellow combatant). Survivor guilt is a state of intense emotional distress experienced by the weight of knowing that one survived while others did not. METHODS: This study of the Translational Research Center for TBI and Stress Disorders (TRACTS) analyzed structural and diffusion-weighted magnetic resonance imaging data from 132 male Iraq/Afghanistan veterans with PTSD. The Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV) was employed to classify guilt. Thirty (22.7 %) veterans experienced guilt over acts of commission or omission, 34 (25.8 %) experienced survivor guilt, and 68 (51.5 %) had no posttraumatic guilt. White matter microstructure (fractional anisotropy, FA), cortical thickness, and cortical volume were compared between veterans with guilt over acts of commission or omission, veterans with survivor guilt, and veterans without guilt. RESULTS: Veterans with survivor guilt had significantly lower white matter FA compared to veterans who did not experience guilt (p < .001), affecting several regions of major white matter fiber bundles. There were no significant differences in white matter FA, cortical thickness, or volumes between veterans with guilt over acts of commission or omission and veterans without guilt (p > .050). LIMITATIONS: This cross-sectional study with exclusively male veterans precludes inferences of causality between the studied variables and generalizability to the larger veteran population that includes women. CONCLUSION: Survivor guilt may be a particularly impactful form of posttraumatic guilt that requires specific treatment efforts targeting brain health.

The nonverbal expression of guilt in healthy adults.

Guilt is a negative emotion elicited by realizing one has caused actual or perceived harm to another person. One of guilt's primary functions is to signal that one is aware of the harm that was caused and regrets it, an indication that the harm will not be repeated. Verbal expressions of guilt are often deemed insufficient by observers when not accompanied by nonverbal signals such as facial expression, gesture, posture, or gaze. Some research has investigated isolated nonverbal expressions in guilt, however none to date has explored multiple nonverbal channels simultaneously. This study explored facial expression, gesture, posture, and gaze during the real-time experience of guilt when response demands are minimal. Healthy adults completed a novel task involving watching videos designed to elicit guilt, as well as comparison emotions. During the video task, participants were continuously recorded to capture nonverbal behaviour, which was then analyzed via automated facial expression software. We found that while feeling guilt, individuals engaged less in several nonverbal behaviours than they did while experiencing the comparison emotions. This may reflect the highly social aspect of guilt, suggesting that an audience is required to prompt a guilt display, or may suggest that guilt does not have clear nonverbal correlates.

The perceived guilt and innocence of adults with developmental language disorder and adults with typical language during a mock interrogation.

PURPOSE: This study examined if there were differences in the guilty and not guilty judgments of adults with developmental language disorder (DLD) and those with typical language (TL) functioning. METHOD: Twenty-four adults (12 DLD, 12 TL) were assigned to either the guilty or not guilty conditions. Those in the guilty condition engaged in a mock crime while those in the not guilty condition were informed that a crime had been committed. Peer jurors were presented with video interrogations of the DLD (6 guilty, 6 not guilty) and TL (6 guilty, 6 not guilty) participants and were asked to make categorical judgments of guilty and not guilty and to indicate confidence in their judgments. RESULTS: In general, peer jurors were not accurate in their judgments of the accused, and were more likely to judge individuals with DLD as guilty relative to accused individuals with TL. Peer jurors were particularly poor at judging innocent adults with DLD as not guilty and guilty adults with TL as guilty. Despite this, peer jurors were more confident than not in their guilty and not guilty determinations. CONCLUSIONS: Peer jurors are confident in their judgments of the guilt of the accused when they should not be, particularly in the case of accused adults with DLD. Implications are discussed.

Motives matter: The psychological experience of ostracizing among sources.

Individuals ostracize others for myriad reasons, yet the influence of those reasons on the psychological experience of ostracizing is yet unknown. Two studies aimed to determine the emotional and behavioral sequelae of ostracizing for different motives, directly comparing punitive to defensive motives. We focused our examination on a suite of emotions expected to arise as a function of (1) the situations that give rise to ostracizing for punitive and defensive reasons (anger, fear, anxiety, and sadness) and (2) the act of ostracizing itself (i.e., pride and guilt). The research employed a novel paradigm to induce the experience of ostracizing for defensive or punitive motives. Study 1 (N = 372) investigated sources' experienced emotion as a function of motive. Study 2 (N = 743) expanded consideration to behavioral intentions, including intentions to continue ostracizing and to recruit others to join in ostracizing the target. Across both studies and supported by an internal meta-analysis, ostracizing for defensive reasons was associated with higher levels of guilt, fear, and anxiety, and lower levels of anger, compared to ostracizing for punitive reasons. Neither sadness nor positive emotion (pride or happiness) differed significantly according to motive in either study. Moreover, guilt and anger mediated the impact of motive on intentions to continue ostracizing and recruit others to join them in ostracizing. To the extent that punitive sources experienced anger relative to defensive sources, they expressed greater intentions to continue ostracizing the target and to recruit others to join in ostracizing the target. To the extent that defensive sources experienced guilt relative to punitive sources, they reported reduced intentions to continue ostracizing the target. Findings add to a growing literature on ostracism sources, and highlight the mediating role of sources' emotion in guiding future actions.

Virtual reality-assessment of social interactions and prognosis in depression.

BACKGROUND: Freud proposed that excessive self-blame-related motivations such as self-punishing tendencies play a key role in depression. Most of the supporting evidence, however, is based on cross-sectional studies and questionnaire measures. METHODS: In this pre-registered (NCT04593537) study, we used a novel Virtual Reality (VR) task to determine whether maladaptive self-blame-related action tendencies prospectively identify a subgroup of depression with poor prognosis when treated as usual over four months in primary care. Ninety-eight patients with depression (Patient Health Questionnaire-9 ≥ 15), screening negatively for bipolar and alcohol/substance use disorders, completed the VR-task at baseline (n = 93 completed follow-up). RESULTS: Our pre-registered statistical/machine learning model prospectively predicted a cross-validated 19 % of variance in depressive symptoms. Contrary to our specific predictions, and in accordance with Freud's observations, feeling like punishing oneself emerged as prognostically relevant rather than feeling like hiding or creating a distance from oneself. Using a principal components analysis of all pre-registered continuous measures, a factor most strongly loading on feeling like punishing oneself for other people's wrongdoings (ß = 0.23, p = 0.01), a baseline symptom factor (ß = 0.30, p = 0.006) and Maudsley Staging Method treatment-resistance scores (ß = 0.28, p = 0.009) at baseline predicted higher depressive symptoms after four months. LIMITATIONS: Patients were not assessed with a diagnostic interview. CONCLUSIONS: Independently and apart from known clinical variables, feeling like punishing oneself emerged as a distinctly relevant prognostic factor and should therefore be assessed and tackled in personalised care pathways for difficult-to-treat depression.

Person-specific dynamics between negative emotions and suicidal thoughts.

INTRODUCTION: Recent technology has enabled researchers to collect ecological momentary assessments (EMA) to examine within-person correlates of suicidal thoughts. Prior studies examined generalized temporal dynamics of emotions and suicidal thinking over brief periods, but it is not yet known how variable these processes are across people. METHOD: We use data EMA data delivered over two weeks with youth/young adults (N = 60) who reported past year self-injurious thoughts/behaviors. We used group iterative multiple model estimation (GIMME) to model group- and person-specific associations of negative emotions (i.e., fear, sadness, shame, guilt, and anger) and suicidal thoughts. RESULTS: 29 participants (48.33%) reported at least one instance of a suicidal thought and were included in GIMME models. In group level models, we consistently observed autoregressive effects for suicidal thoughts (e.g., earlier thoughts predicting later thoughts), although the magnitude and direction of this link varied from person-to-person. Among emotions, sadness was most frequently associated with contemporaneous suicidal thoughts, but this was evident for less than half of the sample, while other emotional correlates of suicidal thoughts broadly differed across people. No emotion variable was linked to future suicidal thoughts in >14% of the sample, CONCLUSIONS: Emotion-based correlates of suicidal thoughts are heterogeneous across people. Better understanding of the individual-level pathways maintaining suicidal thoughts/behaviors may lead to more effective, personalized interventions.

Vortex of regret: How positive and negative coping strategies correlate with feelings of guilt.

Bad coping behavior and guilt may reinforce each other as a negative feedback loop. Social contexts and expectations may also create cognitive dissonance in coping individuals and affect the effectiveness of coping styles. This study examines the associations between the feeling of guilt and specific coping styles belonging to both groups of positive and negative coping styles. We conducted Bayesian Multiple Regression analyses on secondary data from 3784 high school students in China. Positive coping is associated more with reduced feelings of guilt compared to negative coping. However, some positive coping styles were found to be positively associated with a sense of guilt, especially those involving confrontation against or conformity to social expectations. Most negative coping styles are positively associated with guilt, and substance use has the strongest influence among the examined negative coping styles. The findings suggest that the consideration of sociocultural contexts is very important in supporting those with guilt issues, especially adolescents in societies with dominant traditional East Asian values.

Perceived stress and posttraumatic growth in caregivers of pediatric burn patients undergoing mHealth-enhanced outpatient burn care: A pilot study.

Approximately 120,000 children in the United States are evaluated in the emergency department annually due to burn injuries. Studies have consistently documented that pediatric burns are among the most stressful events for caregivers, resulting in a wide range of emotions, including guilt, anxiety, grief, depression, and posttraumatic stress symptoms, as well as positive psychological changes, a phenomenon known as posttraumatic growth. The present pilot study aimed to explore the prevalence of elevated perceived stress as well as posttraumatic growth among caregivers of pediatric burn patients receiving outpatient burn care and using an mHealth burn platform to administer burn treatment. Our results demonstrated that, on average, caregivers endorsed similar or lower levels of perceived stress over the past 30 days compared to the general population of 30-44-year-old adults and only a third of caregivers reported elevated levels of perceived stress in the past 30 days. However, during the treatment phase, two-thirds of caregivers reported elevated levels of stress. Further, approximately half of the caregiver sample reported moderate to high levels of posttraumatic growth following their child's burn injury. This pilot study clarifies the level of the perceived stress that caregivers of burn-injured children experience, particularly during the treatment phase when they are responsible for their children's outpatient burn care (e.g., dressing changes). Additionally, the results shed light on the high prevalence of moderate to high posttraumatic growth in caregivers, with a prevalence rate similar to other trauma survivors.

Internalized Sexual Stigma and Mental Health Outcomes for Gay, Lesbian, and Bisexual Asian Americans: The Moderating Role of Guilt and Shame.

The literature unequivocally demonstrates that lesbian, gay, and bisexual (LGB) individuals experience disproportionate mental health and social wellbeing impacts. Here, we respond to recent calls for research in the field of sexual minority health to better understand why various overlapping and intersecting identities can further drive health disparities. In this paper, we focus on the specific intersections of ethnicity and sexuality for Asian LGB individuals and the role of internalized stigma in driving poorer mental health outcomes for this group. We recruited 148 LGB Asian participants residing in the United States (Mage = 22.82 years, SD = 4.88) to participate in our online cross-sectional survey in which we collected data on their internalized stigma, levels of guilt and shame about their sexuality, and measures of depression, anxiety, and distress. Contrary to our predictions, there were no bivariate relationships between internalized sexual stigma and any of the mental health outcomes. However, a parallel mediation analysis revealed that guilt, but not shame, mediates the relationship between internalized sexual stigma and all mental health outcomes (depression, anxiety, and stress) for LGB Asian American individuals. This research highlights the important of exploring additional variables that may exacerbate of protect against poor mental health for individuals with multiple intersecting identities.

A latent profile analysis of moral emotions following moral transgressions.

OBJECTIVE: Moral transgressions (MTs), events that violate one's moral code, are associated with the moral emotions of guilt and shame. However, there may be different patterns by which people experience guilt and shame that affect distress following MTs. METHOD: Undergraduates (N = 1371) exposed to an MT completed self-report assessments. This study used latent profile analysis (LPA) to examine profiles based on guilt cognitions, internalized shame, and distress in relation to a reported MT. Cognitive flexibility, years since the MT, and deliberate and intrusive rumination were examined as variables to determine how these factors predicted profile membership. RESULTS: Results from the LPA revealed a three-profile solution: a low moral distress profile (n = 1002), a moderate moral distress profile (n = 262), and a shame prominent profile (n = 107). Results indicated that higher levels of deliberate and intrusive rumination and lower levels of cognitive flexibility significantly increased the likelihood of belonging to the moderate moral distress or shame prominent profiles compared to the low moral distress profile. Higher levels of intrusive rumination and lower levels of cognitive flexibility also significantly increased the likelihood of belonging to the shame prominent profile over the moderate distress profile. CONCLUSION: Three different profiles emerged, with the shame prominent profile being driven primarily by internalized shame. Results suggest that intrusive rumination and cognitive inflexibility are risk factors to experiencing adverse responses to MTs.

Using the Moral Injury and Distress Scale to identify clinically meaningful moral injury.

Despite the proliferation of moral injury studies, a remaining gap is distinguishing moral injury from normative distress following exposure to potentially morally injurious events (PMIEs). Our goal was to leverage mental health and functional measures to identify clinically meaningful and functionally impairing moral injury using the Moral Injury and Distress Scale (MIDS). Participants who endorsed PMIE exposure (N = 645) were drawn from a population-based sample of military veterans, health care workers, and first responders. Using signal detection methods, we identified the optimally efficient MIDS score for detecting clinically significant posttraumatic stress and depressive symptom severity, trauma-related guilt, and functional impairment. The most efficient cut scores across outcomes converged between 24 and 27. We recommend a cut score of 27 given that roughly 70% of participants who screened positive on the MIDS at this threshold reported clinically significant mental health symptoms, and approximately 50% reported severe trauma-related guilt and/or functional impairment. Overall, 10.2% of respondents exposed to a PMIE screened positive for moral injury at this threshold, particularly those who identified as a member of a minoritized racial or ethnic group (17.9%) relative to those who identified as White, non-Hispanic (8.0%), aOR = 2.52, 95% CI [1.45, 4.42]. This is the first known study to establish a cut score indicative of clinically meaningful and impairing moral injury. Such scores may enhance clinicians' abilities to conduct measurement-based moral injury care by enabling them to identify individuals at risk of negative outcomes and better understand risk and protective factors for moral injury.

Differences in the link between social trait judgment and socio-emotional experience in neurotypical and autistic individuals.

Neurotypical (NT) individuals and individuals with autism spectrum disorder (ASD) make different judgments of social traits from others' faces; they also exhibit different social emotional responses in social interactions. A common hypothesis is that the differences in face perception in ASD compared with NT is related to distinct social behaviors. To test this hypothesis, we combined a face trait judgment task with a novel interpersonal transgression task that induces measures social emotions and behaviors. ASD and neurotypical participants viewed a large set of naturalistic facial stimuli while judging them on a comprehensive set of social traits (e.g., warm, charismatic, critical). They also completed an interpersonal transgression task where their responsibility in causing an unpleasant outcome to a social partner was manipulated. The purpose of the latter task was to measure participants' emotional (e.g., guilt) and behavioral (e.g., compensation) responses to interpersonal transgression. We found that, compared with neurotypical participants, ASD participants' self-reported guilt and compensation tendency was less sensitive to our responsibility manipulation. Importantly, ASD participants and neurotypical participants showed distinct associations between self-reported guilt and judgments of criticalness from others' faces. These findings reveal a novel link between perception of social traits and social emotional responses in ASD.

Individuals with Nazi and Nazi-Sympathizer Family History: Psychotherapeutic Issues.

This article presents the findings of an ongoing supervision group (founded in 1999) researching the after-effects of the Nazi period on people in psychotherapy in Germany today. The unacknowledged collective shadow hidden behind half-truths, prevarications, and silence itself prevents a genuine working through of the Nazi past. Patients' lack of knowledge concerning their families' own past leads to unconscious guilt, which often then leads to psychosomatic disturbances. But this is not only a problem in Germany. Unacknowledged collective shadows are prevalent in many countries worldwide. Psychological difficulties on the individual and societal levels result.